Provider Demographics
NPI:1033751201
Name:CLUTTER, JULIET (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:CLUTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 TRICKHAM BND
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1169
Mailing Address - Country:US
Mailing Address - Phone:402-960-7077
Mailing Address - Fax:
Practice Address - Street 1:7630 N BEACH ST STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-3016
Practice Address - Country:US
Practice Address - Phone:817-281-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006914363A00000X
TXPATEMP363A00000X
TXPA15760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant